The Outcomes of Tonsillectomy in Obese Pediatric Patients with Obstructive Sleep Apnea
Wang, John E.
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INTRODUCTION: Pediatric obstructive sleep apnea (OSA) is characterized by obstruction of the upper airway during sleep leading to inadequate ventilation. OSA is a common disorder, occurring in 1-4% of young children that can cause attention problems, a reduced quality of life, increased sympathetic tone and cardiovascular abnormalities. The first line treatment for OSA in children is a tonsillectomy (with or without adenoidectomy or T&A.) However, the rate of resolution of OSA (tested by polysomnography [PSG]) after T&A is not as high as expected in obese children. The primary objective of this study is to compare the outcomes of T&A between normal-weight and overweight, and obese children. The secondary objective is to determine any potential predictors for improvement or resolution. METHODS: A cohort of 112 obese and 114 non-obese children aged 2-18 years who underwent PSG, a subsequent T&A for OSA, and a post-op PSG at Children's Medical Center UT Southwestern, Dallas was included. Demographics, clinical findings, and polysomnographic parameters (before and after T&A) were recorded. RESULTS: Obese patients had a higher AHI post-op than non-obese patients (7.6 and 3.7 respectively [p-value=.027]). Weight gain among obese patients positively predicted the residual AHI, indicating that the residual AHI increases as post-op weight gain increases (Coefficient 1.66; 95% CI 0.54 to 2.77; t=8.5, p=0.003; Y-intercept = 24.8+1.66X). Among obese patients, presence of asthma also predicts higher residual AHI, with asthma and obesity showing a multiplicative effect (p-value=.015). We also found that obese patients gained more weight (8.8 kg) than non-obese patients (4.9 kg) (p-value<.001). CONCLUSION: Our study reinforces previous findings that obese patients have a lower resolution of OSA than other children. Furthermore, we found that obese patients were also more likely to gain weight after T&A than overweight and normal-weight patients. In obese patients, those that gained more weight were more likely to have residual obstructive sleep apnea. This study brings up the question of weight management in the obese pediatric OSA patient with T&A. In addition, obese patients that also had asthma were also more likely to have residual OSA. It is possible that the nasal congestion and bronchoconstriction in asthma magnifies the effect of fat deposition on the airway.